Healthcare Provider Details

I. General information

NPI: 1033271002
Provider Name (Legal Business Name): PHARMACY OF J IVERSON RIDDLE DEVELOPMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 03/07/2024
Certification Date: 03/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 ENOLA RD PHARMACY DEPARTMENT
MORGANTON NC
28655-4608
US

IV. Provider business mailing address

CBO DHHS CONTROLLERS OFC 2021 MAIL SERVICE CENTER
RALEIGH NC
27699-0001
US

V. Phone/Fax

Practice location:
  • Phone: 828-433-2653
  • Fax: 828-433-2894
Mailing address:
  • Phone: 919-733-9867
  • Fax: 919-733-1512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336I0012X
TaxonomyInstitutional Pharmacy
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number02677
License Number StateNC

VIII. Authorized Official

Name: JANICE SWEARINGEN
Title or Position: DIRECTOR OF PHCY SVCS
Credential: RPH
Phone: 828-433-2683